Date: _______________

Name: _________________________________________________

Mailing Address: _________________________________________

____________________________________ Zip: ______________

Phone number: (_____) ______ - __________

Paying by Credit Card: (VISA and MASTERCARD)

Card #: ________________________________________________

Name on Card: ___________________________________________

Exp. Date: _____________

Authorized Signature:_____________________________________________________

Please make checks payable to "West Virginia University"

Please mail completed form (along with check) to:

WVU Marching Band Recordings
Division of Music
PO Box 6111
Morgantown, WV 26506-6111
304-293-3097